Camp Gan Izzy Application Summer 2019
Register your child for the ultimate day care experience!
Child's full name *
Your answer
Mother's Name *
Your answer
Father's Name *
Your answer
Home Phone Number *
Your answer
Mother's Cell *
Your answer
Father's Cell *
Your answer
Mother's Email Address *
We send most correspondence via email to receive all important school information.
Your answer
Father's Email Address *
We send most correspondence via email to receive all important school information.
Your answer
Home Address: *
Your answer
Child's Date of Birth: *
Your answer
Age on June 1st, 2019: *
Your answer
Please choose from the following programs: *
Select only one!
Infant/Toddler early/After Care Option
Select only one!
Summer Only or Summer & School Year? *
Select only one!
Required
Please read carefully: We will contact you regarding your registration within 3 business days. Upon receiving this registration form, we will set up an interview to determine that the program is a correct fit for your child. The non-refundable registration fee for the summer only program, is $125. For the school year or summer/school year, a registration of $500 is due upon enrollment ($250 which is credited towards the last months tuition). Sign up for 2 consecutive sessions (summer and school year or school year and summer) and save an extra $125! *
The registration fee is non-refundable; initial below:
Your answer
I agree to allow my child's pictures to be used for promotional purposes. Please initial below: *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Chabad of Passaic - Clifton.